Provider Demographics
NPI:1841441193
Name:FEICK, JEAN TS (CNP, CDE)
Entity type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:TS
Last Name:FEICK
Suffix:
Gender:F
Credentials:CNP, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 PIERCE STREET
Mailing Address - Street 2:SUITE D
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870
Mailing Address - Country:US
Mailing Address - Phone:419-557-5541
Mailing Address - Fax:419-557-5542
Practice Address - Street 1:1111 HAYES AVE
Practice Address - Street 2:DIABETES CLINIC
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-3323
Practice Address - Country:US
Practice Address - Phone:419-557-6990
Practice Address - Fax:419-621-2202
Is Sole Proprietor?:No
Enumeration Date:2008-10-06
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN127264163WD0400X
OHNP10121363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00752833OtherMEDICARE RR
OH2953031Medicaid
OHFENP29231Medicare PIN